Glaucoma

In normal conditions, intraocular pressure oscillates between 10 and 21 mm of Hg. In certain pathological situations, this may increase acutely or chronically. This increase in intraocular pressure can damage the optic nerve, which causes a progressive loss of peripheral vision. In most cases, this change is gradual and painless, so many patients do not even realise it until it is permanent and irreversible.

Who can it affect?

Glaucoma affects over 3% of the population and it is, together with diabetes, the main preventable cause of blindness in Spain. It primarily affects people over 40 and those with a family history of glaucoma.

Symptoms

The pain felt by a patient varies depending on the type of glaucoma that he/she has.

Chronic glaucoma is the most frequent type, and in its beginning phases no sort of pain is felt. If the pressure continues to be high for a prolonged period of time, the optic nerve is affected and peripheral vision deteriorates slowly. In advanced stages, vision is reduced to the central area of the visual field, making the patient feel as though he/she were looking through a tube, and it may lead to total vision loss.

Acute glaucoma is much less frequent. It is characterised by intense pain, which suddenly begins around the eye area, and by a decrease in vision. In some cases, it can be accompanied by headaches, nausea and vomiting. If you have these symptoms, you should immediately call/visit an ophthalmologic specialist.

Detection of glaucoma

Intraocular pressure can be measured using quick and painless tests. The condition of the retina and optic nerve can also be evaluated in a non-intrusive manner.

In the event of a family history of glaucoma and/or when such procedures show some sort of anomaly, a computerised perimetry test should be carried out.

Treatment

The best treatment for glaucoma is early diagnosis in those situations in which intraocular pressure is high and/or the optic nerve is beginning to be damaged. Due to the fact that most cases of blindness caused by glaucoma occur without symptoms and that it can be prevented, it is essential to perform checks every one or two years in any person over 40.

Therapeutic options

Medical treatment
The most common way to treat glaucoma is by applying drops. The aim is to decrease intraocular pressure. If the treatment is done correctly, in most cases it is possible to stop glaucoma from getting worse.

Laser
If the pressure is not controlled with medical treatment, the next option is to use a laser. This procedure aims to help ocular fluid leave the eye and thus reduce intraocular pressure.

Surgery
This is the last step in the treatment of glaucoma. It consists of expanding the zone where intraocular fluid leaves the eye by making an exit valve or by implanting an artificial drain valve.

The surgery is performed using local anaesthesia. When glaucoma is associated with the presence of cataracts, the two procedures can be done at the same time.

What happens afterward?

It is not possible to know if the glaucoma is controlled according to how the patient sees or feels, since there is no type of pain that indicates such information. Making periodic visits to the ophthalmologist is the only way to know if the glaucoma is correctly controlled.

Nonetheless, once glaucoma has been detected and treated and the pressure on the eyeball returns to normal levels, deterioration of the optic nerve is not very common.